Inspection on 23/11/07 for Peel House Nursing and Residential Home

This inspection was carried out on 23rd November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Peel House Nursing and... 02/08/06

Peel House Nursing and... 24/11/05

Peel House Nursing and... 04/07/05

Peel House Nursing and... 07/01/05

Peel House Nursing and... 03/08/04

Peel House Nursing and... 17/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Peel House Nursing and Residential Home Woodcote Lane Fareham Hampshire PO14 1AY Lead Inspector Anita Tengnah Unannounced Inspection 10:00 23 November 2007 rd X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Peel House Nursing and Residential Home Address Woodcote Lane Fareham Hampshire PO14 1AY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01329 667724 Mr Zamir Afghan Mrs Parigul Afghan Position vacant Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46), Physical disability (9), Physical disability of places over 65 years of age (46), Terminally ill (9), Terminally ill over 65 years of age (46) Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users must be at least 50 years of age. Date of last inspection 2nd August 2006 Brief Description of the Service: Peel House is a registered care home to provide nursing and personal care for service users in the older person category. The Home is also registered to take service users who are terminally ill or have a physical disability. The home can take up to 46 service users. The home is located in the rural outskirts of Fareham. There are some local shops and other amenities within easy reach. The home is a converted domestic type house with over two-storey building that has been extended to provide more communal accommodation on the ground floor. The home has a mixture of single rooms and double bedrooms some with ensuite facilities. There is a passenger lift that provides level access to the home. There were some building works at the service at the time of the visit as part of the extension of the home. The garden was in the process of being landscaped and was not in use. The current fee charged is £600-£650 per week. Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit to the service was undertaken as part of the inspection on the 23rd of November 2007. As part of the visit we used a process of spending some time sitting alongside the residents in the lounge. This gave us the opportunity to observe the residents state of well-being and staff interaction with the residents during this time. We also looked at a number of the bedrooms, communal areas, kitchen, and bathrooms, laundry. As part of case tracking 5 staff and 4 service users views were sought and care records were looked at. Information gained from the Annual Quality Assurance Assessment (AQAA) was used and included in this report, as was information gathered by the commission since the last inspection to contribute in assessing judgements in this report. Positive comments were received from the service users regarding the care that they were receiving at the home. The commission received 9 comment cards from the service users and some contained input from their relatives. Care practices observed at the time of the visit showed that care was provided in a respectful manner. What the service does well: What has improved since the last inspection? Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 6 The bathing facilities have improved and two shower facilities have been put in place, one of these was near completion at the time of the visit. The residents’ prescribed creams were managed safely. Some parts of the home had been refurbished. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 3,6 The pre admission assessment process is good and ensures that service users’ needs are assessed and the home can meet them. The home does not provide intermediate care. EVIDENCE: The care records of two recently admitted service users were looked at as part of case tracking. The manager or her deputy assessed all the service users prior to admission. Assessments of needs included dietary needs, moving and handling assessments, skin integrity. There were no care manager’s assessments available for those that were social services funded. The manager reported that they did not receive them and would ensure that these are sought as part of the admission process. Staff reported that the pre admission Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 9 assessment information was used to formulate their initial plan of care on admission. The manager reported that the prospective clients are offered the choice of visiting the home prior to admission. Staff reported that the residents were often too frail to visit, however their family visited. Comments received included “ my daughter looked at the service and thought it would be suitable“. The manager confirmed that the service does not provide intermediate care. Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans are detailed and provide adequate information to the staff. The review of care plans to reflect current needs of the service users will ensure that care needs are fully met. The health care needs and access to external agencies are satisfactory The medication management was satisfactory The service users were treated with respect and their dignity maintained. EVIDENCE: The care plans of 3 service users were seen as part of this visit to look at how the home plans to meet the needs of the service users. The care plans seen contained information about the assessed needs of the service user and actions required in order to meet them. This included assessments such as manual Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 11 handling, dietary needs, continence, medication, social contacts and life history. It was evident that the staff had spent time discussing the likes, dislikes, family history, hobbies in two of the plans seen in order to formulate plan of care around those needs. There was evidence that the care plans were reviewed at regular intervals to take into account any changes in their needs. It was noted that some of the residents had bed rails in place, however there were no assessments and consents in the records seen this was discussed with the nurse in charge and must be addressed. The daily records seen contained detailed information about the care given and any changes in the treatment. There was a multi disciplinary record of care maintained to include GP visits. The manager reported that all the people using the service are registered with the local surgery. The home had good relationship with the local primary care trust and the people were supported to access health care services as required. One of the residents was supported to access treatment three times a week at the local hospital. The GP was available on request and the manager stated that a review of the residents’ medication was undertaken at regular intervals. The home has a medication policy and procedure in place and the manager reported that only the registered nurses were responsible for the medication management at the service. All medication was stored securely and included controlled drug. A sample of the Medication Administration Records (MAR) sheets showed that the staff maintained a record of all prescribed medication administered. Staff described the process of ordering and recording medication received into the service, and were aware of the Royal Pharmaceutical guidelines. A random check of creams/ ointments kept in the residents’ rooms indicated that they were dispensed to those that these were prescribed for. A requirement was made at the last visit relating to prescribed ointments and this has been met. As part of our observation of people using the service, we found that staff interacted well with people and treated them with respect. However all the interactions occurred when the staff were completing tasks such as serving drinks in the morning. The residents and staff used touch and staff informed them of what they were about to do. All those observed showed signs of positive interaction. However there were long periods of time when nothing happened in the lounge and two in particular showed signs of ill being/ agitation. There was a lack of presence/supervision of staff in the communal lounges. Although there were two televisions with the sound on very loud, none of them showed any interests in these. This was the cause of irritation to one of the people who shouted at the television. The way that choices are offered with regards to drinks and snacks was discussed with the manager and would be addressed. The residents were treated with respect and their dignity maintained when Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 12 being attended to. Staff spoke to the residents in a respectful manner and the carers appeared to interact well with the people using the service. Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 12,13,14,15 The social and recreational facilities for the service users meet with their satisfaction. The service users autonomy and choices are respected in their activities of daily living. The residents are offered choices and variety with their meals. EVIDENCE: The home has a planned and varied programme of activities for the residents. These included games, bingo, and regular external entertainers visited the home. The manager reported that the home was without an activity coordinator and that the carers undertook activities with the residents in the afternoon between 2-3 pm. The home also has a volunteer that came in daily Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 14 and played cards and bingo with the residents. The game card observed was interactive and the residents appeared to enjoy. Records of activities were seen and were detailed. Information such as strength and weakness, social contact and life history had been put in place in some of the care plans seen and staff reported that the activity coordinator worked with the residents in developing these further. Comments received included “activities usually available but not every week.” Another comment was “there are activities at the home but I am not physically and mentally able to take part in some of them” . The home has an open visiting policy and it was evident from the record of visitors as kept by the home that there was no restriction on visiting. The local vicar visited regularly and held monthly prayers and hymns for the residents. One of the resident indicated that she was going out to her “stroke club” that afternoon. The home has a planned menu that is rotated on a regular basis. Comment cards received and the service users spoken with said that the meals were “very good” and hot and cold drinks were available at all times. Comments included “meals very appetising. I do enjoy every meal” and “ the food is very good”. Another comment received was “meals not always hot. Vegetable not cooked and tired of chicken x3 times a week and tea not hot”. This was brought to the attention of the manager. The lunchtime meal was observed and meals were well presented and appeared appetising and nourishing and different types of meals were provided. Staff were available to offer support with meals and meal was not rushed. It was noted that hot puddings were served at the same time as the hot meal for those having their meals in their bedrooms. This was also brought to the attention of the manager who reported that she would be addressing this with staff. Staff were observed to assist the residents in choosing their meals from the set menu for the following day. Comments were “ if someone does not like what on the menu they can have something else.” Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 16,18 The complaint management is good and the people are confident in raising any concerns with staff. Staff demonstrated clear understanding of adult protection and ongoing training ensures that the service users are protected. EVIDENCE: The home has a complaint policy and procedure comments received indicated that they would approach the staff in charge. Comments included “I would talk to the staff”. Other comment was “I am very happy here at Peel House. The staff are all very kind and helpful. The complaint log as maintained at the service was looked at. The manager had received 6 concerns/complaints and records showed that there had been a prompt response to all concerns raised. A thorough investigation was carried out and all of them had been resolved. The home has the Hampshire adult protection procedure and staff spoken with had clear understanding of what constituted abuse and would report to the manager. The manager reported that all staff are issued with the whistle Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 16 blowing procedure as training in safeguarding adults forms part of the induction for staff. Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 19,26 The home provides the people with a clean and homely accommodation. Some of the shared rooms did not provide the same standards. The infection control procedures at the home are satisfactory. The management of personal toiletries needed improvement. EVIDENCE: A tour of the premises was undertaken as part of the visit and a number of bedrooms, communal areas, bathrooms, and kitchen were viewed. The home was warm, clean and homely. Furnishing was appropriate to the needs of the people using the service. The residents are provided with large communal areas where a variety of activities are undertaken. Most of the bedrooms seen were personalised and in good state of repair. Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 18 The staff reported that a new shower room had been put in place since the last visit and another shower room was near completion on the day of the inspection. All shared rooms had mobile screens available, however some of the screens had the wheels missing that made them unstable and may pose a danger to the residents. The shower room on the ground floor was also in need of refurbishment, the shower curtain was heavily stained and staff reported was difficult to clean. Some of the shared rooms lacked the personal touches and did not appear homely. One of them had stained wallpaper and peeled paintwork to door frames. Others lacked furnishing such as bedside tables and lamps. Staff reported that this should have been in place and would be addressed. One of the shared bedrooms also accommodated one of the resident that required hoisting and did not appear to have much room to manoeuvre and may compromise on the space for the other person. The personal toiletries in the shared rooms were not labelled/ kept separately and could be mixed up. The home has a laundry and all the service users’ laundry is undertaken internally. There was information displayed and policies and procedures for infection control. Staff practices observed indicated that they were aware of these and adhered to them. Different coloured aprons for example were used for serving of meals and care tasks. The laundry room was clean and fitted washing machines and tumble dryers that staff reported worked well. A hand washing facility was available and the laundry floor was impermeable that allowed for easy cleaning. Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 27,28,29,30 The staffing numbers are adequate to meet the present needs of the service users. The home has system in place to ensure that staff have the skills to deliver care safely. The recruitment process is very good. All checks are undertaken prior to employment to ensure the safety of the service users. EVIDENCE: The home has a duty roster for carers and a separate roster for the ancillary staff. Staff and service users spoken with confirmed that they felt that there were mostly adequate staff to meet their needs. The record of the duty roster showed that there are 3 trained staff and 6 carers on the early shift, 2 trained staff and 5 carers on the afternoon/ evening shift and 1 trained staff and three carers on night duty. Comments received included” the staff are all very kind and helpful” the residents felt they were supported and staff were available. One comment was “ Care staff work very hard due to shortage of staff”. Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 20 The staff confirmed that staffing levels remained the same at the weekends. Care staff were observed to demonstrate good interaction with people using the service. The home has a recruitment procedure and the manager interviewed all job applicants. A sample of newly recruited staff seen indicated that the home’s recruitment process was followed. All necessary checks were undertaken including CRB and POVA first and references secured prior to employment. The home has an ongoing training programme in place to ensure that all staff have mandatory training in health and safety. A senior staff member was responsible for the induction and training in health and safety including moving and handling. Records of moving and handling for new staff were not available at the time of the visit. Other training included National Vocational Qualification (NVQ) at level 2. Information from the AQAA indicated that there are 12 carers who have achieved NVQ 2 or above and 6 carers were working towards achieving this qualification. Information received indicated that the home’s induction meets with the Skills for Care guidance. Further development in training planned included palliative care training for the trained staff in conjunction with the local hospice. Also dementia care, mental capacity act, abuse awareness and diabetes care. Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 31,3,35,38 The home has a manager with day-to day management responsibility for the service. The financial interests of the service users are safeguarded through good accounting. The process of seeking the service users’ views is satisfactory. There is a satisfactory procedure in place to ensure the health and safety of the service users are promoted. EVIDENCE: Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 22 The home has a manager who has completed the Registered Manager’s Award and has years of experience in the care of the elderly. The manager reported that she has the day-to-day management responsibility for the service. The deputy manager supported her in her role. Staff spoken with stated, “this was a good home to work at “. Other comments included “we all work well together” and “you can go to the nurse in charge if you need anything”. The manager has been in post since January 2007 and to date has not applied to the commission to be registered. This was discussed and a manager’s application must be submitted as required. A sample of the personal allowance as managed by the home was looked at. There was a robust system in place and all the service users’ monies were kept separately. Receipts and invoices were maintained of transactions. Random checks of three of the service users’ personal accounts were found to be accurate. All transactions undertaken with the service users were recorded accurately including their signatures for money withdrawn maintained. Information received indicated that there are regular reviews of policies and procedures to ensure that they meet current legislation/ guidelines. There is an ongoing programme for the servicing of fire equipment, hoists, lift and emergency lighting. Records seen showed that they were all completed at regular intervals. Staff practices observed indicated that they were aware of manual handling procedures and followed these when transferring people on different occasions. All substances that are hazardous to health (COSHH) were kept locked away. Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 13(4) (a) (c) Requirement The ground floor shower facility and the shared bedrooms must be reviewed to ensure they are in good state of repair and appropriate to the service users’ needs. The registered person must ensure that an application to register the manager is submitted to the commission. Timescale for action 15/01/08 2 OP31 9(1) (2) 15/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Peel House Nursing and Residential Home DS0000043173.V350058.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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